Individual
GLENN ALLEN GEHRKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8001 CENTERVIEW PKWY STE 215, CORDOVA, TN 38018-4276
(901) 249-5905
(901) 249-5940
Mailing address
67 LAKEVIEW DR, PADUCAH, KY 42001-5619
(270) 554-8373
(270) 554-8987
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
4301080570
MI
207LP2900X
Pain Medicine (Anesthesiology) Physician
4301080570
MI
208VP0000X
Pain Medicine Physician
24839
MS
208VP0000X
Pain Medicine Physician
53805
TN
208VP0014X
Interventional Pain Medicine Physician
24839
MS
208VP0014X
Interventional Pain Medicine Physician
4301080570
MI
208VP0014X
Interventional Pain Medicine Physician
Primary
53805
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07274365
—
MS
01
—
6066289
BLUE CROSS BLUE SHIELD
TN
01
—
P01704491
RAILROAD MEDICARE
—
05
—
Q022062
—
TN
Enumeration date
10/23/2006
Last updated
04/04/2019
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